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General NPI Number Information
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NPI Number | 1508159112
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Entity Type | Individual
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Provider Name | CASIE LYNN DEBARDI OTR/L
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Gender | Female
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Dates
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Enumeration Date | 05/16/2011
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Last Update Date | 05/16/2011
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Provider Practice Location Address
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Address Line | 3435 W VAN BUREN ST
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City | CHICAGO
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State | IL
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Zip | 60624-3312
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Country | US
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Telephone | 773-826-6400
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 103
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City | REEDSVILLE
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State | WV
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Zip | 26547-0103
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Country | US
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Telephone | 304-282-9672
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 056.009371
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License Number State | IL
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